Chronic kidney disease (CKD) is a public health problem with ~20 million affected in the US. CKD is known to have adverse effects on the cardiovascular system, the aging process as well as cognitive function. The aim of this K24 program is provide support for Dr. Sarnak's patient oriented research (POR) program and mentorship for his trainees in these topics. Dr. Sarnak is currently supported as the Principal Investigator though three Federal grants including those from the 1. The Cardiovascular Risk Factors in Kidney Disease Pooling Project 2. Kidney Disease in the Cardiovascular Health Study, a cohort study of older adults and 3. Cognition and Vascular Disease in Dialysis Patients. These three studies as well as a wide variety of other multicenter collaborations provide opportunities for hypothesis generation and independent research for Dr Sarnak's trainees. Since 2000 Dr. Sarnak has mentored 15 residents or research fellows, and been senior author on 21 peer-reviewed articles with his mentee as the first author. Three of his previous mentees are currently POR's and members of the Division of Nephrology at Tufts New England Medical Center. His mentees would be supported by a T32 National Research Service Award (NRSA DK007777), as well as current and future K23 awards that have been awarded to Division of Nephrology. Dr. Sarnak is the Associate Director of the T32 NRSA. All trainees would complete 1) Didactic Training - course work in fulfillment of the MS degree in the Graduate Program in Clinical Research at the Sackler School of Graduate Biomedical Sciences at Tufts University. 2) Independent Study - an hypothesis-based research project supervised by a Dr. Sarnak and a research team of faculty with expertise in other disciplines and 3) Training in Presentation - participation in conferences and seminars designed to improve trainees'oral and written presentations. K23 awardees mentored by Dr. Sarnak also participate on his research team and in mentoring, creating an outstanding environment for training new clinician-investigators. This application also includes a new proposal for long term follow up of the randomized and non randomized cohorts of the Modification of Diet in Renal Disease (MDRD) Study with the broad aims of evaluating risk factors for kidney failure, hypoalbuminemia and cardiovascular disease at the time of kidney failure, and all cause mortality in 15 years of follow-up. CKD is a public health problem of epidemic proportions with profound implications in terms of morbidity, mortality and resource utilization. Preventing the development and retarding the progression of CKD, as well as its associated complications such as cardiovascular disease, unsuccessful aging and development of cognitive abnormalities, will potentially impact the health of the nation and reduce health care costs. Training future investigators in POR will be essential to reduce the burden of CKD in the future.